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't <br /> d� <br /> !r <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS'WASTE DISCHARGE Fly HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELQ II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: @29 -4(a-f - e333 <br /> Company: <br /> Address: 5Z0 _ A( un(o,-) <br /> Designated Employee Name: Jerry Yoshioka <br /> Sny Phone: 468-0335 , <br /> Reporting Agency Name: 2ublYc Health Services - Environmental Health Divison <br /> Address: 304 E_ Weber Ave Stockton, CA 95201 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2_00 N , q <br /> (Best Physical Description) i't or County) Circle One <br /> Date of Discharge: L.jLccc L <br /> Date Notified: I//Z/ Time: �7f' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: _ _ S� �i ,i F. .� <br /> Contact Person: 116 , &-`C_U:�c r- Telephone: <br /> Physical Address__8,Z00 A/, N. w u „4'(q <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: Unauthorized Release discovered upon . _ <br /> Volume: Unknown <br /> Chemicals: C-�;Sa/•:�c C C/t7/ rc! <br /> Circumstances: Review of results of third-2arty soil sampling obtained <br /> during UST removal and subsequent laboratory analyses . <br /> F. ACTION TAKEN. �.00IC re <br /> SITE DISPOSI TION <br /> EH 22 013 (Rev.4/9I) <br />